AB0969 FAILURE OF THE FIRST BIOLOGIC IN PATIENTS WITH SPONDYLOARTHRITIS: DATA FROM THE MOROCCAN RBSMR REGISTRY
Authors: S. Mikou, I. El Mezouar, M. Maiouak, N. Akasbi, I. Hmamouchi, R. Abouqal, A. Bezza, F. Allali, R. Bahiri, I. El Bouchti, I. Ghozlani, H. Hassikou, I. Linda, S. Janani, R. Niamane, A. El Maghraoui, T. Harzy
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Spondyloarthritis is a group of chronic inflammatory rheumatism most often affecting young adults. Biological background treatments have revolutionized their care, although some patients have failed these treatments. <h3>Objectives</h3> To estimate the prevalence of failure of the first biological treatment during spondyloarthritis and the factors associated with this failure. <h3>Methods</h3> Our study included patients with Spondyloarthritis retained according to the ASAS criteria, having an age &gt; 18 years, treated with biological treatment, having given their written informed consent, in the 10 rheumatology departments in Morocco, collected from the RBSMR registry, a multicenter historical-prospective registry. Primary failure was defined as failure at 6 months of treatment and secondary failure as failure at more than 6 months of treatment. Patients were assessed every six months with a scheduled follow-up of three years. Inclusion began in June 2017 and ended in January 2019, when the database was first frozen. <h3>Results</h3> 194 patients included. The average age was 40.23 years +/- 13.68, the sex ratio was 1.73 M/F, the average duration of evolution was 615.9 weeks +/- 349.12. An HLA B27 antigen was positive in 66% of patients. Peripheral involvement was found in 70% of patients, axial involvement in 96.4% of patients and enthesic involvement in 61.5% of patients. Radiographic sacroiliitis was present in 87.6% of patients, radiographic coxitis in 40.7% and sonographic coxitis in 19.8%. Regarding extra-articular manifestations, 14.5% of patients had anterior uveitis, 6.9% had cutaneous psoriasis, and 10.7% had associated chronic inflammatory bowel disease. The ASDAS CRP was in high activity in 50.9% of the patients and the BASDAI (spondyloarthritis activity index) more than 4 in 79.2% of the patients. At the first visit, 22.5% of patients were taking corticosteroid therapy and 53.8% were taking csDMARDs. The most widely used biological was Etanercept with a percentage of 33%. Over a follow-up period of 03 years, 05 primary failures were objectified and 17 secondary failures to the first biological treatment (08 failures at the 12th month, 06 failures at the 18th month and 03 failures at the 24th month), the prevalence of failure of the first biological was 8.76%. In bivariate analysis, no statistically significant factors were observed associated with the failure of the first biological during the visit of the 6th month, the 12th month or that of the 24th month. At the visit of the 18th month, the average BASDAI as well as that of the C reactive protein (CRP) was statistically higher in patients who failed the first biological. <h3>Conclusion</h3> The failure of the first biological is a rather rare situation in our study. Certain factors were significantly associated with this failure and must be taken into account when managing patients, namely high values of BASDAI and CRP. Higher values of the Bath Spondylitis Functional Index (BASFI) or CRP at baseline are predictors of a greater risk of failure of the first biological found in the literature. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.